The Sonic Track Club

MEMBERSHIP APPLICATION

2008

Birth Certificates _______

MEMBER INFORMATIONName

_____________________________________

Birth Date

_______________

Sex

____ Last First Initial Month/Day/Year M / F

Address

__________________________________________________________ Number Street __________________________________________________________ City State Zip Code

Home Phone

(_____)______________

Cell Phone

(_____)________________ Area Code Number Area Code Number

E-mail Address

______________________________________

2008 Age GroupsAAUUSATF

Primary - Born 2000 and afterBantam- 1998 and under Sub-Bantam - Born 1999Midget- 1996-1997Bantam- Born 1998 Youth - 1994-1995Sub-Midget - Born 1997 Intermediate - 1992-1993Midget - Born 1996 Young men/women- 1990-1991Sub-Youth - Born 1995Youth - Born 1994Intermediate - Born 1992-1993Young Men/Women - born 1990-1991

Parent/Guardian Information

Father’s Name _______________________ Home Phone ___________ Work Phone ___________ Mother’s Name ______________________ Home Phone ___________ Work Phone ___________ Guardian’s Name _____________________ Home Phone ___________ WorkPhone_____________ Other Emergency Contact _______________ Home Phone ___________ Work Phone _____________

Release and Waiver and Medical Information & Release

List Member’s Illnesses, Physical Conditions, Allergies, etc. (For example, “Asthma”) _______________________________________________________________________ (If none, please write “NONE”.)